Primary choledochoduodenostomy for benign obstructive biliary tract disease.

Area of Science:

• Gastroenterology
• Surgical Oncology
• Geriatric Medicine

Background:

• Repeated biliary ductal surgery increases risks, especially in elderly patients.
• Benign obstructive lesions of the biliary tract necessitate effective primary interventions.

Purpose of the Study:

• To evaluate the safety and efficacy of side-to-side choledochoduodenostomy as a primary procedure in elderly patients with benign biliary obstruction.
• To assess long-term outcomes, including morbidity, mortality, and reoperation rates.

Main Methods:

• A cohort of 54 elderly patients (mean age 72 years) underwent primary side-to-side choledochoduodenostomy for benign biliary tract obstruction.
• Indications included common/hepatic duct stones, incomplete duct clearance, dilated ducts, and ampullary stenosis.
• Patients were followed for 2-16 years, with outcomes assessed for mortality, complications, and recurrent biliary symptoms.

Main Results:

• No operative or hospital mortality was observed.
• Mean postoperative hospital stay was 12.3 days, with minor complications in 18 patients (none requiring reoperation).
• Long-term follow-up (mean 7.8 years) showed no biliary tract-associated deaths or reoperations, with 27 patients remaining free of biliary complaints.

Conclusions:

• Side-to-side choledochoduodenostomy is a safe and effective primary treatment for elderly patients with benign biliary obstruction.
• The procedure offers low morbidity and zero reoperation rates, serving as both therapy and prophylaxis against common duct stones.
• This approach remains a viable option despite advancements in endoscopic techniques.